在巴基斯坦农村地区，与政府管理的医疗机构相比，利用签约医疗机构提供的母婴健康服务的感知障碍。
Perceived barriers to utilizing maternal and neonatal health services in contracted-out versus government-managed health facilities in the rural districts of Pakistan.
机构信息
Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Women and Child Health Division, Aga Khan University, Karachi, Pakistan.
出版信息
Int J Health Policy Manag. 2015 Mar 6;4(5):279-84. doi: 10.15171/ijhpm.2015.50.
BACKGROUND
A number of developing countries have contracted out public health facilities to the Non-Government Organizations (NGOs) in order to improve service utilization. However, there is a paucity of in-depth qualitative information on barriers to access services as a result of contracting from service users' perspective. The objective of this study was to explore perceived barriers to utilizing Maternal and Neonatal Health (MNH) services, in health facilities contracted out by government to NGO for service provision versus in those which are managed by government (non-contracted).
METHODS
A community-based qualitative exploratory study was conducted between April to September 2012 at two contracted-out and four matched non-contracted primary healthcare facilities in Thatta and Chitral, rural districts of Pakistan. Using semi-structured guide, the data were collected through thirty-six Focus Group Discussions (FGDs) conducted with mothers and their spouses in the catchment areas of selected facilities. Thematic analysis was performed using NVivo version 10.0 in which themes and sub-themes emerged.
RESULTS
Key barriers reported in contracted sites included physical distance, user charges and familial influences. Whereas, poor functionality of health centres was the main barrier for non-contracted sites with other issues being comparatively less salient. Decision-making patterns for participants of both catchments were largely similar. Spouses and mother-in-laws particularly influenced the decision to utilize health facilities.
CONCLUSION
Contracting out of health facility reduces supply side barriers to MNH services for the community served but distance, user charges and low awareness remain significant barriers. Contracting needs to be accompanied by measures for transportation in remote settings, oversight on user fee charges by contractor, and strong community-based behavior change strategies.
背景
为了提高服务利用率，许多发展中国家已将公共卫生设施外包给非政府组织（NGO）。然而，由于缺乏从服务使用者角度出发的深入定性信息，因此对于因外包而导致的服务获取障碍知之甚少。本研究的目的是从服务使用者的角度探讨在政府外包给 NGO 提供服务的医疗机构（外包机构）和由政府管理的医疗机构（非外包机构）中利用母婴健康（MNH）服务的感知障碍。
方法
这是一项在 2012 年 4 月至 9 月期间在巴基斯坦农村的 Thatta 和 Chitral 地区的两个外包和四个非外包的基层医疗保健机构进行的基于社区的定性探索性研究。通过半结构式指南，在选定设施的集水区中，对母亲及其配偶进行了三十六次焦点小组讨论（FGD），收集了数据。使用 NVivo 版本 10.0 进行了主题分析，其中出现了主题和子主题。
结果
在外包点报告的主要障碍包括物理距离、用户收费和家庭影响。而非外包点的主要障碍是医疗中心功能不良，其他问题相对不那么突出。两个集水区的参与者的决策模式基本相似。配偶和岳母特别影响了利用卫生设施的决定。
结论
将卫生设施外包减少了社区获得母婴健康服务的供应方障碍，但距离、用户收费和低意识仍然是重大障碍。外包需要与针对偏远地区的交通措施、对外包商用户收费的监督以及基于社区的强有力的行为改变策略相结合。
Zotero 插件